Medicare Compliance & Reimbursement

One Baltimore-based oncology practice learned the hard way that the feds don’t mess around with inappropriate E/M claims.

Scoop: On Sept. 12, Frederick Oncology and Hematology Associates, P.C. (FOHA) agreed to pay the government more than $850,000 to settle allegations the firm had inaccurately billed Medicare for E/M claims using the wrong modifier.

Between Jan. 1, 2013 and Nov. 1, 2017, “FOHA improperly submitted claims for evaluation and management using a code modifier that is only appropriate when there is a separate and distinct evaluation and management service on the same day as a procedure or other service being performed on a patient,” a Department of Justice (DOJ) release explains. “FOHA submitted and was paid for those improperly billed claims when FOHA did not perform a separate and distinct evaluation and management.”

During that time period, FOHA also submitted improper claims using a physician’s National Provider Identifier instead of the non-physician practitioner's NPI who’d actually provided the service when the physician was absent.

Find the DOJ release and settlement breakdown at www.justice. gov/usao-md/pr/frederick-medical-practice-pays-united-states-more-850000-resolve-claims-it.